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What separates people who reach 90 from those who do not?
A new study suggests the answer may lie in habits and health measures established decades earlier.
Researchers who tracked thousands of men over most of their adult lives found a striking pattern: the more cardiovascular risk factors they kept under control in midlife, the more likely they were not only to live longer, but also to enjoy better health and wellbeing in old age.
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While the benefits were greatest for those who maintained healthy habits in midlife, lead researcher Professor Emeritus Timo Strandberg told Newsweek it's "never too late" to improve key risk factors such as smoking, blood pressure and cholesterol.
"For obesity, it’s best to prevent before midlife... but in old age weight reduction must be performed sensibly and combined with exercise and proper nutrition to prevent loss of muscle," he said.
The findings come from the long-running Helsinki Businessmen Study, which followed 2,690 healthy Finnish men from a mean age of 42 into their later years.
Researchers examined five low-risk factors measured in early midlife: not smoking, having a body mass index (BMI) below 25, maintaining systolic blood pressure below 140 mmHg, keeping total cholesterol below 6.0 mmol/L and having healthy blood sugar levels after a glucose test.
The study, published in European Journal of Preventive Cardiology, found that longevity increased steadily with each additional low-risk factor.
Among men who had none of the five factors at baseline, just 6.8 percent reached age 90. Among those who had all five, 41.9 percent lived to 90 or beyond.
But the research went beyond lifespan alone.
Researchers wanted to address a question often raised about healthy living: does it simply add years to life, or does it also improve those years?
When participants were assessed at an average age of 79, those who had entered midlife with the most favorable risk profiles were far less likely to be frail and reported better quality of life across a range of measures.
They also scored higher for psychological wellbeing and tended to report greater happiness.
Among men with all five low-risk factors, only 2.2 percent were classified as frail in old age, compared with 24.5 percent among those with none.
The group with the healthiest midlife profiles also reported higher wellbeing scores and better health-related quality of life in several domains.
Asked which of the five factors people should prioritize, Strandberg said the answer depends on the individual.
"If you are a smoker, stopping is the best one option," he said. "Between blood pressure and cholesterol, it may be difficult to choose and requires individual assessment which is higher and therefore more dangerous."
The researchers noted that the study is unusual because it followed participants for up to 60 years, allowing them to examine not just mortality but also quality of life near the end of the lifespan.
By January 2025, nearly 94 percent of participants had died, giving investigators a rare opportunity to assess the long-term impact of midlife health on aging outcomes.
There are important caveats. The study included only men, most of whom were socioeconomically similar and living in Finland, meaning the findings may not apply equally to other populations.
In addition, the research was observational, meaning it cannot prove that the five factors directly caused better outcomes.
Still, the researchers found men who entered middle age with more favorable cardiovascular health were not only more likely to reach 90, but also more likely to arrive there with less frailty, a better quality of life and a greater sense of wellbeing.
"We already [have] feasible and practical solutions to treat all five factors and improve possibilities for happier old age without specific geroscience or complex biohacking," Strandberg said. "I think this is our study’s main message."
Reference
Strandberg, T E., Strandberg, A Y., , Pitkälä, K H., Kivimäki, M., Low cardiovascular risk in early midlife and quality of life in old age: a life-long follow-up study in men, European Journal of Preventive Cardiology, 2026;, zwag429, https://doi.org/10.1093/eurjpc/zwag429
Contact Newsweek editors on this story: Kara Dolman and Emma Lee-Sang
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